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Interview with Emily

I thought it was about time to share with you all, more details about Partners In Heath, the organisation I am volunteering with, here in Malawi and what better way than to talk to the Chief Medical Officer, Emily Wroe at Partners in Health (PIH), Abwenzi Pa Za Umoyo (APZU)

A quote from Paul Farmer co-founder of PIH:

The essence of global health equity is the idea that something so precious as health might be viewed as a right’

1. Tell me about PIH and its philosophy

PIH is a US based Non-Government Organisation (NGO) who’s mission is to create preferential healthcare for the poor based on the premise that access to healthcare is a basic human right. They do this by establishing long term relationships with sister organizations and local ministries, based in settings of poverty, to bring the benefits of modern medical science to those most in need and to serve as an antidote to despair.

We go. We make house calls. We build health systems. We stay.

PIH acknowledges the long-term commitment and the holistic approach to healthcare and provide this by investing in the 4S – Staff, Supply chains, Space (facilities) and Systems. They achieve this by accompanying Governments and patients to determine what they need to improve healthcare, including provision of social and financial support

2. Tell me about the history of PIH-APZU

In June 17 PIH -APZU celebrated its 10th anniversary in Malawi. Back in 2007 PIH were invited by the Government of Malawi to assist, as usual, in the most difficult & challenging places where no one else operates, hence PIH’s presence in Neno. In 2007 there were about 120,000 people in the area with no hospitals, 10 health centres in a state of disrepair and mountainous terrain with limited road network. Since then PIH have worked with the Ministry of Health to refurbished the 10 heath centres, build 2 new hospitals & 2 additional health centres and these now serve the 165,000 people in the Neno district, where 95% of the population live on less than $1.50/day and 50% are under the age of 15.

Some interesting fact about Malawi:

Total population: 17 million

Life expectancy: 57 years for men and 60 years for women

Child mortality: 64 per 1,000 (compared to 3.7 per 1,000 births in UK)

Maternal mortality: 510 per 100,000 (compared to 10 per 100,000 in UK)

Prevalence of HIV: 11% and tuberculosis: 193 per 100,000

~3 million confirmed cases of malaria in 2014

Official languages are English and Chichewa

Population living below national poverty line: 72%

Some interesting facts about Neno;

Very rural district in mountainous southern Malawi

Majority of the 165,000 people rely on subsistence agriculture

Only 4.3% of the population have electricity.

Neno became a district in 2003, a district hospital was built in 2007, and a community hospital was added in 2011.

PIH began working in Neno in 2007 at the invitation of the MOH and the Clinton Hunter Development Initiative.

To complement the clinical programmes there are also community programmes like Community Health Workers who visit people in their homes, checking on the health needs of entire households, screening them for a wide array of diseases, catching health problems early and referring patients to health centres for treatment. POSER (Program on Social and Economic Rights) is another community programme and organizes job-skills training and employment programs (including in trades such as carpentry, tailoring, knitting, cookery, and farming) to help patients and their families lift themselves out of poverty. The program also provides monetary support like help pay for school fees or uniforms and school supplies, or refurbishing and even building houses for the most vulnerable families. PIH are now pioneering the integrated chronic care clinics for combined HIV and non-communicable disease care, and research suggests that Neno District is one of those rare places where patients can have most of their chronic health conditions taken care of in a single visit. In most other health care facilities in sub-Saharan Africa, if you come for HIV treatment, for example, you must return later for additional appointments for non-communicable diseases like diabetes and hypertension.

Neno is now a centre for innovation and learning and so PIH are now partnering to help the Central Ministry of Health develop healthcare strategy plans for the whole of Malawi

3. How did you come to work for PIH

Like many working in global health, the first-time Emily came into contact with devastating poverty and suffering was while on a voluntary trip to Nicaragua as an undergraduate, she was horrified. After graduation, she then worked for 1 year in Tanzania and decide this was the field she wanted to work in. Emily did her MD at Harvard where she met Joia Mukherjee the Chief Medical Officer for PIH and decided she wanted to work with impoverished countries in resource limited settings. She spent 18 months in Rwanda, did her residency at Brigham and Women’s hospital and finally came to Malawi in 2014 as Chief Medical Officer

4. Tell me about the type of staff/volunteers at PIH-APZU

There are about 290 PIH staff working in Neno of which <10 are expats and yes, many are clinical staff, like doctors & nurses, but we run big community health programmes with local staff who interact with >1,000 Community Health Workers all of whom come from the local community. We also have pharmacists, laboratory staff, clinic clerks, monitoring & evaluation and bioinformatics roles. There are over 200 people working at PIH who are not medically qualified and who work in several departments including Operations, Supply Chain & Warehouse, Finance, HR, IT, Infrastructure, Transport

PIH actively support medical students, Global Health fellows, rotating medics & family practitioners, from both Malawi and other countries and actively run mentoring and capacity building programmes within the facilities. They also conduct many global health research projects with key institutions across the globe.

5. What is the future vision for PIH-APZU and what do you need to accomplish it

APZU’s vision is to continue supporting the public sector to strengthen the healthcare system in Malawi, help reduce the burden of disease and provide healthcare that people need. There needs to be global advocacy for equality in healthcare provision, and APZU is currently focusing on the areas of non-communicable diseases and maternal health. Key global health research requires continued support to monitor effectiveness of programmes and support policy development. Resources are limited, especially money, but there is a perception that it’s too expensive to care for poor people or its too difficult or won’t work, but work in Neno and at other PIH sites has proved otherwise. Until there is serious redistribution of global funds, there will always be a fight to dispel the myth that there is not enough money to provide equal healthcare to everyone.

Volunteers and visiting fellows are an important part of the whole organisation, not just at the hospitals and clinics, but in operations and non-clinical departments, where often there is even more limited resources and systems

I’ll leave you with another quote from Paul Farmer

‘The idea that some lives matter less is the root of all that is wrong with the world. The only way to do the human rights thing is to do the right thing medically’

If you would like to find out more about PIH, volunteering or donate, please go to https://www.pih.org/

Wow…those facts on Malawi and Neno are frightening. So thankful there are people like Emily and organizations like PIH to support people and to fight for equality in health care. Thanks for sharing this perspective – I found it informative! Merry Christmas, Sylvia!!